Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

The Mother of Mother’s Little Helpers

Just when you thought there were no novel ways to abuse women.

Just when you thought there were no novel ways to abuse women, leave it to the United States Centers for Disease Control and Prevention (CDC) to shake us out of our complacency, and remind us that great harm can be done with a prescription pad—and maybe an incomplete appreciation for the complexity of the human being sitting in that exam room.

It was announced last week that the number of women dying from overdoses of pain-relieving opioid medications had increased five-fold between 1999 and 2010. Not surprisingly, this increase in overdoses and deaths from overdoses of opioid medications is related to the parallel increase in pain-relieving opioid prescription writing on the part of health care providers. A CDC official goes so far as to opine that the abundance of opioid prescription writing has no basis in true patient need.

The data upon which the CDC report is based is from the National Vital Statistics System and the Drug Abuse Warning Network. The authors of the report examined emergency department visits and deaths related to the misuse and abuse of drugs, including overdose; and performed analyses focused upon prescription pain-relieving drugs.

While men are still more likely to die from prescription opioid overdose, women have been outpacing men in that particular category for more than a decade: Since 1999, there has been a 400% increase in deaths of women, versus a 265% increase seen in male prescription drug users. Looking at actual numbers, prescription pain medication overdoses resulted in the deaths of almost 48,000 women between 1999 and 2010. In fact, in 2010, about 18 women died every day from an overdose of a prescription pain-relieving drug. Putting this tragedy into perspective with other overdose tragedies, there were four times as many deaths among women from prescription pain medication overdose than for deaths from cocaine and heroin combined in the year 2010.

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Interestingly, other research has shown that women are more prone to chronic pain, receive more prescription medication in higher dosages for that pain, and use these medications on a more chronic basis compared to men. And in contrast to men, women may become dependent on their prescription pain relief in a shorter period of time and may engage to a greater extent in drifting from doctor to doctor in order to gain refills.

Alas, the CDC can only reiterate to treating entities what other agencies and individuals have previously recommended or suggested:

• Follow opioid prescribing guidelines, including monitoring for psychological pathology and substance abuse characteristics.

• Utilize the prescription monitoring program available locally.

• Refer to pain treatment centers.

• Educate the patient regarding the risk of prescription pain medications, discussing the appropriateness---or inappropriateness, as it were---of opioids for chronic pain.

• Avoid a combination of drugs that might increase the risk of a given patient landing in the local emergency department.

The death rate for women (and men) needs to drop. That very well may start with doctors thinking twice before they write that next script for chronic pain. Treatment options for chronic pain need to be utilized; sometimes this takes more effort than writing a prescription (for example, obtaining insurance authorization for a pain management referral). However, the path of least resistance can too easily become another female fatality.

It already has, maybe 18 times today.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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